Healthcare Provider Details

I. General information

NPI: 1255228532
Provider Name (Legal Business Name): MADELINE MARIE BIRONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 SCIOTO ST
URBANA OH
43078-2255
US

IV. Provider business mailing address

1960 NORTHWEST BLVD
COLUMBUS OH
43212-1147
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-7623
  • Fax:
Mailing address:
  • Phone: 330-806-4873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number30.027986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: